Program Manager-Pharmacy Contracting

Allina Health

32d • $52 - $72

About The Position

Allina Health is a not-for-profit health system that cares for individuals, families and communities throughout Minnesota and western Wisconsin. If you value putting patients first, consider a career at Allina Health. Our mission is to provide exceptional care as we prevent illness, restore health and provide comfort to all who entrust us with their care. This includes you and your loved ones. We are committed to providing whole person care, investing in your well-being, and enriching your career. Key Position Details: 1.0 FTE (80 hours per two-week pay period) 8-hour day shift No weekends Job Description: Oversees proper payer contracting, payer relations, and revenue management for health system pharmacy. Ensures contracting requirements are met and provides analysis, problem resolution, auditing, reporting, process recommendations, and training for optimal business outcomes. Acts as the pharmacy and payer point of contact for related problems/questions. Responsible for in-house financial audits and preliminary analysis including payer performance, contract compliance, and business analysis. Disseminates contract reimbursement information to providers and relevant stakeholders and serves as a key strategic partner with the payer relations and contracting department. Principle Responsibilities Strategy and Execution Develops, implements, and manages a comprehensive, market-based payer strategy to ensure pharmacy network participation and optimization. Ensures the alignment of payer programs with the health system's strategic business initiatives with close alignment to associated stakeholders, i.e., network integrity team. Monitors and assesses network requirements, ensuring compliance with payer standards, credentialing and performance metrics. Supports contract negotiations with commercial insurers, Medicare/Medicaid, and PBMs to optimize network access and reimbursement. Account Management and Payer Relations Establishes relationships with key payer stakeholders, ensuring strong partnerships that drive retention and access with a focus on pharmacy. Conducts regular business reviews with payers to assess performance, contract adherence, and strategic opportunities. Provides subject matter expertise within the credentialing and re-credentialing process for payer contracts and payer network participation. Evaluates and responds to Requests for Proposals (RFPs) and Requests for Information (RFIs) to secure new payer partnerships. Advocates for fair access to pharmacy networks by engaging in payer discussions, policy reviews, and appeals processes. Tracks payer policies and formulary changes, assessing their impact on pharmacy services and patient access. Serves as a point of contact for payer-related escalations, resolving access barriers and reimbursement disputes. Analytics Utilizes data to support strategic decision-making, network expansion, and network maintenance. Provides data-driven insights to payers and internal stakeholders. Communicates pharmacy's value proposition and identify areas for data alignment. Collaborates with revenue cycle and billing teams to analyze and optimize reimbursement and address payer-related issues. Other duties as assigned.

Requirements

• Bachelor's degree in Business, finance or related area
• 5+ years in pharmacy contracting, payer relations, pharmacy network management, or healthcare reimbursement

Nice To Haves

• Master's degree in Business, finance or related area
• 2+ years leadership experience in pharmacy-related contracting, or infusion, specialty, or retail pharmacy
• Registered Pharmacy Technician - MN Board of Pharmacy required upon hire preferred

Responsibilities

• Oversees proper payer contracting, payer relations, and revenue management for health system pharmacy.
• Ensures contracting requirements are met and provides analysis, problem resolution, auditing, reporting, process recommendations, and training for optimal business outcomes.
• Acts as the pharmacy and payer point of contact for related problems/questions.
• Responsible for in-house financial audits and preliminary analysis including payer performance, contract compliance, and business analysis.
• Disseminates contract reimbursement information to providers and relevant stakeholders and serves as a key strategic partner with the payer relations and contracting department.
• Develops, implements, and manages a comprehensive, market-based payer strategy to ensure pharmacy network participation and optimization.
• Ensures the alignment of payer programs with the health system's strategic business initiatives with close alignment to associated stakeholders, i.e., network integrity team.
• Monitors and assesses network requirements, ensuring compliance with payer standards, credentialing and performance metrics.
• Supports contract negotiations with commercial insurers, Medicare/Medicaid, and PBMs to optimize network access and reimbursement.
• Establishes relationships with key payer stakeholders, ensuring strong partnerships that drive retention and access with a focus on pharmacy.
• Conducts regular business reviews with payers to assess performance, contract adherence, and strategic opportunities.
• Provides subject matter expertise within the credentialing and re-credentialing process for payer contracts and payer network participation.
• Evaluates and responds to Requests for Proposals (RFPs) and Requests for Information (RFIs) to secure new payer partnerships.
• Advocates for fair access to pharmacy networks by engaging in payer discussions, policy reviews, and appeals processes.
• Tracks payer policies and formulary changes, assessing their impact on pharmacy services and patient access.
• Serves as a point of contact for payer-related escalations, resolving access barriers and reimbursement disputes.
• Utilizes data to support strategic decision-making, network expansion, and network maintenance.
• Provides data-driven insights to payers and internal stakeholders.
• Communicates pharmacy's value proposition and identify areas for data alignment.
• Collaborates with revenue cycle and billing teams to analyze and optimize reimbursement and address payer-related issues.
• Other duties as assigned.

Benefits

• Medical/Dental
• PTO/Time Away
• Retirement Savings Plans
• Life Insurance
• Short-term/Long-term Disability
• Voluntary Benefits (vision, legal, critical illness)
• Tuition Reimbursement or Continuing Medical Education as applicable
• Student Loan Support Benefits to navigate the Federal Public Service Loan Forgiveness Program

What This Job Offers

• Job Type: Full-time
• Career Level: Manager